恩再适治疗带状疱疹后遗神经痛疗效评价及对BDNF表达的影响

目的:评价牛痘疫苗致炎兔皮提取物(恩再适)治疗带状疱疹后遗神经痛(PHN)的疗效及对脑源性神经营养因子(BDNF)表达的影响。方法:50例PHN患者随机分为两组,对照组给予加巴喷丁、甲钴胺和对乙酰氨基酚曲马多,治疗组在此基础上加用恩再适注射液,疗程14天。采用视觉模拟评分法(VAS)对患者进行疼痛评分并采用酶联免疫吸附法检测患者外周血中脑源性神经营养因子的表达。结果:治疗组疼痛评分较对照组明显减少(P0.01),治疗组外周血中脑源性神经营养因子表达较对照组明显升高(P0.01)。结论:恩再适能显著缓解带状疱疹后遗神经痛,其作用机制与BDNF升高密切相关。     

依达拉奉对脑复苏患者血清神经元烯醇酶(NSE)的影响

目的 观察依达拉奉对脑复苏患者血清特异性神经元烯醇化酶(NSE)的影响.方法 选择心肺复苏(CPR)后恢复自主循环(ROSC)的患者66例,随机分为常规治疗组33例和依达拉奉组33例,常规治疗组给予常规对症支持治疗,依达拉奉组在常规治疗的基础上,加用生理盐水100ml+依达拉奉(edaravone)30mg静滴,2次/d,疗程14 d.两组患者分别在治疗前、治疗后24 h、72 h、7 d、14 d静脉采血,采用酶联免疫吸附法(ELISA)测血清NSE值,对比两组患者在治疗前后血清NSE的变化规律,并注意观察患者的药物不良反应;结果常规治疗组患者死亡23例,持续植物状态6例,预后不良共29例,预后良好仅有4例;依达拉奉组患者死亡22例,持续植物状态6例,预后不良共28例,预后良好仅有5例,两组患者治疗成功率相比,差异无统计学意义(P>0.05).治疗前后两组患者血清NSE值的变化:治疗24 h、72 h、7 d、14 d后,与治疗前相比,两组患者中预后良好的患者血清NSE值均随着治疗时间的延长而逐步降低,差异有显著性意义(P< 0.01或P<0.05),与常规组相比,依达拉奉组降低更加明显,差异有统计学意义(P< 0.01);预后不良的患者血清NSE值与治疗前相比,差异无统计学意义(P>0.05),依达拉奉组与常规组相比,血清NSE值无明显变化,差异无统计学意义(P>0.05).不良反应的观察:依达拉奉组中预后良好的患者未见明显的肝肾功能减退及粒细胞减少等不良反应.结论 心跳呼吸骤停患者大多预后不良;依达拉奉对CPR术后脑复苏患者具有一定的神经保护作用,但并不能改善患者预后; NSE可能可以作为早期判断CPR术后患者脑功能恢复良好的一种生化学指标; 脑复苏患者使用依达拉奉具有一定的安全性.     

血清IL-26、HMGB1与带状疱疹相关性疼痛研究

目的：探讨血清IL-26和高迁移率族蛋白1(HMGB1) 与急性带状疱疹疼痛(AHP)和后遗神经痛(PHN)之间的关系。方法： ELISA方法检测带状疱疹患者57例（AHP 40例, PHN17例）和健康对照组30例血清中IL-26、HMGB1的水平。结果：AHP组和PHN组IL-26平均水平分别为15.97±2.48 pg/mL,13.90±3.86 pg/mL高于对照组的8.00±0.38 pg/mL,差异有统计学意义;PHN组HMGB1平均水平为7.91±9.29 ng/mL明显高于AHP组3.80±6.30 ng/mL和健康对照组4.03±5.45 ng/mL（P<0.05）。AHP 组中疼痛VAS评分与血清IL-26浓度有相关性 (r=-0.435,P<0.05),与HMGB1无相关性（r=0.109,P>0.05）。PHN组中疼痛VAS评分与IL-26和HMGB1水平均无相关性（P>0.05）。结论：IL-26可能与AHP的发病机制有关。     

神经阻滞治疗38例带状疱疹疼痛的疗效观察

目的：观察神经阻滞治疗带状疱疹疼痛的临床疗效。方法：将38例带状疱疹患者采用神经阻滞治疗。结果：总有效率为81．57％，治疗后1个月随访病人未发现有后遗神经痛。结论：神经阻滞治疗能明显有效地减轻带状疱疹疼痛。     

缺氧缺血性脑病早产儿血清Tau蛋白与病情严重程度和预后的关系

目的探讨缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)早产儿血清Tau蛋白与病情严重程度和预后的关系。方法选取2015年4月-2018年12月在南通大学附属建湖医院分娩的70例HIE早产儿为观察组,同期分娩的50例健康新生儿为对照组。根据病情严重程度分为轻、中、重度组,比较各组Tau蛋白、神经特异性烯醇化酶(NSE)、新生儿神经行为评分(NBNA)、智力发育指数(MDI)、运动发育指数(PDI)。分析Tau蛋白与NSE、NBNA、MDI和PDI相关性,采用受试者工作曲线(ROC)评估Tau蛋白对新生儿神经预后的预测价值。结果①70例早产儿轻、中重度组分别为20、30和20例。与对照组相比,观察组出生第7天Tau蛋白、NSE水平升高(P<0.05),NBNA、MDI及PDI指数下降(P<0.05);其中重度组Tau蛋白、NSE水平最高,中度组次之,轻度组最低(P<0.05);重度组BNA评分、MDI和PDI指数最低,中度组次之,轻度组最高(P<0.05)。②与出生第7天比较,三组患儿出生第14天的Tau蛋白、NSE水平均降低(P<0.05),而NBNA评分、MDI和PDI指数均升高(P<0.05)。出生第14天,重度组Tau蛋白、NSE水平高于轻度、中度组(P<0.05),NBNA评分、MDI和PDI指数低于轻度、中度组(P<0.05),而轻、中度组Tau蛋白、NSE、NBNA评分、MDI和PDI指数比较差异无统计学意义(P>0.05)。③Tau蛋白与NBNA评分、MDI和PDI指数呈负相关(r分别为-0.426、-0.358、-0.458,均P<0.05),与NSE水平呈正相关(r为0.527,P<0.05)。④出生第14d,Tau蛋白评估患儿神经预后不良的曲线下面积、灵敏度特异度分别为0.814、80.42%和71.56%。结论HIE早产儿血清Tau蛋白水平明显升高,且与病情严重程度和预后密切相关。     

脑源性神经营养因子与特应性皮炎进展

特应性皮炎的病因与发病机制尚不清楚,可能是遗传因索、免疫因素以及环境因素共同作用的结果.脑源性神经营养因子是炎症性、变态反应性及自身免疫性疾病过程中免疫细胞与神经细胞间的调节成分,其水平与特应性皮炎患者的疾病活动性、严重性及生活质量相关,其在特应性皮炎发病过程中,通过诱导外周血嗜酸性粒细胞趋化、抑制嗜酸粒细胞凋亡、增加抗原特异性IgE的产生而起着一定作用.     

银屑病患者血浆脑源性神经营养因子和VEGF的表达

目的:检测脑源性神经营养因子(BDNF)及血管内皮细胞生长因子(VEGF)在寻常型银屑病(PV)患者血浆中的表达。方法:采用酶联免疫吸附试验(ELISA)分别检测23例进行期PV和19例稳定期PV患者血浆中BDNF及VEGF的表达,并以16名健康志愿者作对照。结果:PV患者血浆中BDNF及VEGF的表达均明显高于正常人(P0.01),进行期患者的表达高于稳定期患者(P0.01);BDNF的表达与PASI评分呈正相关(P0.01),VEGF的表达与PASI评分无明显相关性(P0.05)。结论:BDNF与VEGF可能参与了寻常型银屑病的发病机制。     

血清炎症标志物与带状疱疹后遗神经痛相关性研究

目的:研究带状疱疹患者多种血清炎症标志物的水平与带状疱疹后遗神经痛(PHN)发生的相关性。方法:共纳入165名带状疱疹患者,收集其初次就诊时的外周静脉血,检测全血细胞计数、红细胞沉降率(ESR)、C反应蛋白(CRP)和白蛋白水平。利用单因素分析、Logistic回归分析以及接受者工作特征(ROC)曲线分析评价每个炎症标志物水平与PHN的发生之间的相关性,并筛选出可能具有预测价值的指标。结果:单因素分析表明,年龄、ESR、CRP以及淋巴细胞计数水平与PHN的发生表现出相关性。Logistic回归分析表明,年龄、ESR及CRP水平与PHN的发生也表现出相关性。ROC曲线分析表明,与CRP的水平相比,ESR水平与PHN的发生表现出更强的相关性。结论:血清中ESR及CRP的水平作为一种潜在的指标可能对预测PHN的发生具有一定的价值。     

水凝胶敷料联合心理护理对带状疱疹神经疼痛程度的影响

目的观察水凝胶敷料联合心理护理对带状疱疹患者神经疼痛程度的影响。方法 98例研究对象选自2018年1月至2020年1月于南阳市中心医院接受治疗的带状疱疹患者,采用随机双盲法分为两组,各49例。两组均进行基础治疗,对照组采用水凝胶敷料进行护理,观察组在对照组基础上进行心理护理干预,两组均连续干预4周。观察两组患者神经疼痛程度及心理状况。结果干预4周后,两组患者视觉模拟评分法(VAS)评分、焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分均较干预前低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论水凝胶敷料联合心理护理对带状疱疹患者进行干预,可有效改善患者心理状况,缓解患者神经疼痛程度,值得临床推广。     

血清降钙素基因相关肽、5-羟色胺浓度与带状疱疹疼痛程度相关性分析

目的观察血清降钙素基因相关肽(CGRP)、5-羟色胺(5-HT)浓度与带状疱疹患者疼痛程度的相关性。方法选择2013年4月—2013年7月在我科住院的带状疱疹患者41例,采用视觉模拟评分(visual analogue scales,VAS)法进行疼痛评分,抽取外周静脉血分离血清,酶联免疫吸咐试验(ELISA)检测CGRP和5-HT,SAS软件分析VAS分值与血清CGRP、5-HT的相关性。结果 CGRP浓度与VAS分值呈负相关,相关系数为-0.763,P0.01;5-HT与VAS分值无相关性,相关系数为-0.171,P0.05。结论 CGRP可能对带状疱疹患者疼痛起着重要的调节作用,5-HT在带状疱疹疼痛的作用可能更为复杂。     

带状疱疹后遗神经痛相关危险因素分析

目的：明确带状疱疹后遗神经痛(postherpetic neuralgia,PHN)的危险因素。方法：分析潍坊医学院附属医院2017年9月至2019年2月带状疱疹住院患者的临床资料,依据发病后1个月是否有PHN,分为病例组和对照组。对两组患者进行单因素及多元logistic回归分析。结果：共筛选出513例患者,其中111例发生PHN（21.6%）。单因素分析示年龄、吸烟史、部位、皮疹面积、临床分型、前驱症状、早期治疗时间、使用糖皮质激素、糖尿病与PHN的发生有关。多因素Logistic回归分析结果显示,PHN的危险因素有年龄≥60岁、有吸烟史、发病诱因为精神/焦虑、初始治疗时间＞7天、急性期重度疼痛和糖尿病史(OR=6.013、3.391、6.800、22.071、21.996、3.163, 95％CI：1.694～21.341、1.219～9.436、1.310～35.296、4.049～120.314、2.864～168.946、1.281～7.811,均P＜0.05)。结论：年龄＞60岁、有吸烟史、发病诱因为精神/焦虑、早期治疗时间＞7天、重度急性期疼痛、糖尿病是PHN发生的危险因素。     

阿米替林预防带状疱疹后遗性神经痛的研究

目的评价阿米替林在预防中老年带状疱疹后遗神经痛（post herpetic neuralgia，PHN）的效果。方法采用随机对照研究，117例门诊患者随机分为两组，对照组给予常规治疗，试验组在常规治疗的基础上加用阿米替林，观察疗程1个月。结果试验组疼痛缓解、疼痛消失时间明显缩短，优于对照组，1个月后PHN的发生率显著低于对照组，并有统计学意义（P〈0．01）。结论带状疱疹急性期运用小剂量阿米替林可较快减轻疼痛症状，预防PHN的发生。     

Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study

Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow‐up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low‐dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN.     

Effectiveness and safety of lidocaine patch 5% to treat herpes zoster acute neuralgia and to prevent postherpetic neuralgia

Herpes zoster is often associated to acute neuralgia and postherpetic neuralgia (PHN). Their therapeutic management is still challenging: among therapeutic options, lidocaine patch 5% was rarely used in acute neuralgia on lesional skin, and its efficacy to prevent PHN was never studied. The efficacy and tolerability of lidocaine patch 5% was evaluated in 38 patients with acute neuralgia (19) and PHN (19). Pain intensity was investigated using DN4 questionnaire and NRS‐11 scale at baseline and at week 2, 4, and 8. The use of rescue therapy was also evaluated. A significant reduction of DN4 and NRS‐11 was observed already at W2, with further improvement at W4 and W8. A complete response to treatment (DN4 and NRS‐11 = 0) at week 8 was higher in patients with acute neuralgia (63.2%) than PHN (31.6%). Rescue therapy gradually decreased in acute neuralgia patients from week 2 (57.9%) to week 8 (10.5%), with only two patients needing neuroleptics. In PHN patients rescue therapy remained stable (68.4%). According to our results, lidocaine patch 5% applied on lesional skin was well tolerated and ensured a rapid pain relief in acute neuralgia; if early used, it prevented PHN in almost all patients.     

199例带状疱疹后遗神经痛相关危险因素分析

目的:分析带状疱疹后遗神经痛(postherpetic neuralgia, PHN)发病相关因素,为临床PHN的预防和治疗提供依据。方法:采用回顾性分析,收集2015年8月至2020年6月广州市第一人民医院199例带状疱疹住院患者临床资料,根据皮疹消失后1个月是否有神经痛,分为PHN组57例和非PHN组142例。收集两组患者的年龄、性别、发病部位、发病时间、临床分型、急性期疼痛程度、血红蛋白水平、白蛋白水平、糖皮质激素使用情况以及是否合并高血压、糖尿病等临床资料。采用单因素及多因素Logistic回归分析。结果:单因素分析示：年龄、发病时间、临床分型、急性期疼痛程度以及白蛋白水平、血红蛋白水平具有统计学差异(P<0.05),而性别、发病部位、糖皮质激素治疗、是否患有高血压、糖尿病则无统计学差异(P>0.05);多因素Logistic回归分析示：血红蛋白水平<120 g/L,年龄≥70岁、发病时间≥7天、临床分型为大疱型、急性期重度疼痛均为PHN发病的独立危险因素,而低白蛋白水平及未使用糖皮质激素不是PHN发病的独立危险因素(P>0.05)。结论:患者年龄≥70...     

地塞米松防治带状疱疹所致神经痛疗效评价

目的:评价地塞米松在治疗带状疱疹神经痛以及预防带状疱疹后遗神经痛中的有效性和安全性。方法:将60例带状疱疹患者随机分为治疗组和对照组,两组患者均静滴更昔洛韦,口服甲钴胺、维生素B_1、氨芬曲马多。治疗组同时给予地塞米松5 mg静滴,每日1次。结果:治疗4天后,治疗组VAS评分低于对照组,有显著统计学意义(P0.05)。治疗组和对照组的后遗神经痛的发病率分别为9.67%和27.59%(P0.05)。结论:早期使用地塞米松可有效缓解带状疱疹神经痛,并能有效预防后遗神经痛。     

Thermography as a predictor of postherpetic neuralgia in acute herpes zoster patients: a preliminary study

Background/purpose: Infrared thermal images in patients suffering from herpes zoster (HZ) may exhibit thermal asymmetry due to the unilateral distribution of HZ lesions. This study examined the usefulness of infrared thermography in acute HZ as a predictor for the development of postherpetic neuralgia (PHN). Methods: The authors collected demographic and clinical data including age, sex, onset of skin lesion, pain intensity by a visual analogue scale (VAS) and the development of PHN from a total of 55 patients diagnosed with HZ. We evaluated the body surface thermographic parameters between the lesion and contralateral normal skin: maximal difference in the temperature (ΔT) and the size of the body surface area (BSA) showing thermal asymmetry. Results: Temperatures of the lesions were found to be warmer than the control side in most patients with acute HZ. We compared the patient group who developed PHN with those who did not. In univariate analysis, patients with PHN were older (P=0.004), had a higher VAS score for pain (P<0.001), higher ΔT (P<0.001) and larger BSA (P=0.001). In logistic regression analysis to identify independent risk factors of PHN, older age (>60 years old) and ΔT more than 0.5 °C were found to be statistically significant.     

Thermal imaging in acute herpes zoster or post-zoster neuralgia

Background/aims: Asymmetry of normal skin temperature patterns has been reported in patients with herpetic disorders. The aim of the study was to describe the temperature distribution in patients suffering from acute herpes zoster or post-herpetic neuralgia.
Methods: Biographic data, including age, gender and time of onset of the skin lesions, were recorded. The distribution of pain was investigated by pain mapping, and the intensity of pain and dysesthesia was quantified by a visual analogue scale. Infrared thermal images of the affected body regions were performed in all possible views using either an Agema 870 or a NEC San-ei Thermotracer.
Results: The mean temperature difference between the affected and the unaffected sides of the body in all patients was 0.52±0.30°C. Higher temperatures were detected in early cases with a disease duration of 1–9 days (mean temperature difference: 0.62±0.36°C) than in patients with pain scores greater than 79 (mean temperature difference: 0.48±0.33°C). Only 6 of 57 patients presented with a temperature difference between the affected side and contralateral side of less than 0.2°C.
Conclusion: Thermal asymmetry of the skin is a common finding in patients with acute herpes. However, the thermal patterns seem to correlate better with the duration of the disease than with the intensity of pain.